Provider Demographics
NPI:1114213063
Name:KNUDSEN, THOMAS (PHARMD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:
Last Name:KNUDSEN
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:835 N 3050 E
Mailing Address - Street 2:
Mailing Address - City:ST GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84790-9041
Mailing Address - Country:US
Mailing Address - Phone:435-256-0002
Mailing Address - Fax:
Practice Address - Street 1:835 N 3050 E
Practice Address - Street 2:
Practice Address - City:ST GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84790-9041
Practice Address - Country:US
Practice Address - Phone:435-256-0002
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-20
Last Update Date:2021-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT6628519183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist